SPATIAL SPILLOVER EFFECTS OF RESOURCE ALLOCATION ON SERVICE VOLUME AND EXPENDITURE IN SECONDARY VERSUS TERTIARY HOSPITALS, CHINA
Author(s)
Jing Liu, PhD1, Xiaoqian Gong, MM1, Tao Zhang, PhD2;
1Yuebei People's Hospital, Medical College, Shantou University, Shaoguan, China, 2Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
1Yuebei People's Hospital, Medical College, Shantou University, Shaoguan, China, 2Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
OBJECTIVES: Objectives: China's healthcare system faces significant challenges in resource distribution, with a pronounced bias toward higher-level facilities. This study investigates the spatial spillover effects of resource allocation on hospital service volume and expenditures, comparing secondary and tertiary hospitals across different regions.
METHODS: Methods: Utilizing a comprehensive dataset from 95 urban public hospitals (54 secondary, 41 tertiary) in Shanxi Province (2013-2019), we employed the spatial Durbin model to analyze the impact of resource allocation on outpatient visits, inpatient admissions, and associated expenditures. Resource allocation metrics included hospital-level indicators (registered physicians, operational beds, high-value medical equipment, government subsidies) and prefecture-level indicators (hospital distribution, bed allocation, physician distribution). Spatial relationships were determined using geolocation data.
RESULTS: Results: The analysis revealed complex spatial interdependencies. While resource levels positively correlated with service outputs within individual hospitals, significant spillover effects were observed: (1) Tertiary hospital bed capacity negatively impacted outpatient visits (β = -0.108, p < 0.05); (2) Secondary hospital physician numbers reduced local outpatient visits (θ = -96.433, p < 0.05) while increasing neighboring secondary hospitals' outpatient expenditures (θ = 1.433, p < 0.01); (3) Tertiary hospital bed concentration decreased neighboring prefectures' inpatient expenditures (θ = -146.734, p < 0.01); (4) Tertiary hospital physician concentration reduced neighboring prefectures' inpatient admissions (θ = -48.130, p < 0.01) but increased expenditures (θ = 104.094, p < 0.05); (5) Secondary hospital concentration boosted neighboring prefectures' tertiary hospital admissions (θ = 818.423, p < 0.01).
CONCLUSIONS: Conclusion: Increasing resources enhances local hospital services and generates spillover effects on neighboring facilities. While the spillover effects from tertiary hospitals may benefit neighboring regions dominated by secondary hospitals, government efforts to control rising medical expenditures by strengthening secondary hospitals may encounter challenges. These insights emphasize the necessity for system-level planning that considers spatial relationships in resource allocation to optimize healthcare outcomes and mitigate unintended consequences.
METHODS: Methods: Utilizing a comprehensive dataset from 95 urban public hospitals (54 secondary, 41 tertiary) in Shanxi Province (2013-2019), we employed the spatial Durbin model to analyze the impact of resource allocation on outpatient visits, inpatient admissions, and associated expenditures. Resource allocation metrics included hospital-level indicators (registered physicians, operational beds, high-value medical equipment, government subsidies) and prefecture-level indicators (hospital distribution, bed allocation, physician distribution). Spatial relationships were determined using geolocation data.
RESULTS: Results: The analysis revealed complex spatial interdependencies. While resource levels positively correlated with service outputs within individual hospitals, significant spillover effects were observed: (1) Tertiary hospital bed capacity negatively impacted outpatient visits (β = -0.108, p < 0.05); (2) Secondary hospital physician numbers reduced local outpatient visits (θ = -96.433, p < 0.05) while increasing neighboring secondary hospitals' outpatient expenditures (θ = 1.433, p < 0.01); (3) Tertiary hospital bed concentration decreased neighboring prefectures' inpatient expenditures (θ = -146.734, p < 0.01); (4) Tertiary hospital physician concentration reduced neighboring prefectures' inpatient admissions (θ = -48.130, p < 0.01) but increased expenditures (θ = 104.094, p < 0.05); (5) Secondary hospital concentration boosted neighboring prefectures' tertiary hospital admissions (θ = 818.423, p < 0.01).
CONCLUSIONS: Conclusion: Increasing resources enhances local hospital services and generates spillover effects on neighboring facilities. While the spillover effects from tertiary hospitals may benefit neighboring regions dominated by secondary hospitals, government efforts to control rising medical expenditures by strengthening secondary hospitals may encounter challenges. These insights emphasize the necessity for system-level planning that considers spatial relationships in resource allocation to optimize healthcare outcomes and mitigate unintended consequences.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR25
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas